Use of gastroduodenal manometry to differentiate mechanical and functional intestinal obstruction: an analysis of clinical outcome
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J W Frank1, M G Sarr, M Camilleri
1Gastroenterology Research Unit, Mayo Clinic, Rochester, Minnesota.
Objectives:
Our aim was to assess the outcome of patients whose gastrointestinal motility recording suggested intestinal mechanical obstruction.
Methods:
Medical records were reviewed for operative reports and alternative diagnoses during at least 1-yr follow-up.
Results:
During 1988-1992, 27 of 890 consecutive manometric recordings suggested mechanical obstruction: 20 with non-propagated, prolonged contractions, seven with a pattern of non-propagated clustered contractions that lasted > 30 min. Obstruction was confirmed at laparotomy in 17 (including two with progressive systemic sclerosis) and by radiology in one. In confirmed obstruction, 12 of 18 contrast radiographs performed prior to manometry were either normal or nondiagnostic. One laparotomy was negative for obstruction; nine patients who did not undergo laparotomy were classified as unobstructed. Manometric recordings showed prolonged contractions in two, clustered contractions in three, and a mixed pattern in four. Positive predictive values of these patterns for obstruction were: prolonged contractions, 82%; clustered contractions, 57%; and mixed pattern, 56%.
Conclusions:
Thus, non-propagated, prolonged contractions in small bowel should prompt a search for obstruction, even when this is equivocal on barium small bowel radiography.
Insights
Gastrointestinal motility recordings showing non-propagated, prolonged contractions strongly suggest intestinal mechanical obstruction. This pattern warrants further investigation, even if imaging tests are inconclusive.
Area of Science:
- Gastroenterology
- Surgical Diagnostics
Background:
- Gastrointestinal motility recordings are used to assess gut function.
- Identifying mechanical obstruction is crucial for patient management.
Purpose of the Study:
- To evaluate the diagnostic value of gastrointestinal motility recordings in detecting mechanical intestinal obstruction.
- To determine the outcome of patients with manometric findings suggestive of obstruction.
Main Methods:
- Retrospective review of medical records for 890 patients with manometric recordings.
- Analysis of operative reports and diagnoses for at least 1-year follow-up.
- Correlation of manometric patterns with surgical and radiological findings.
Main Results:
- 27 of 890 recordings suggested mechanical obstruction, characterized by prolonged or clustered contractions.
- Obstruction was confirmed in 17 patients via laparotomy and 1 via radiology.
- Positive predictive values for obstruction were 82% for prolonged contractions, 57% for clustered contractions, and 56% for mixed patterns.
- Barium small bowel radiography was often normal or nondiagnostic in confirmed obstruction cases.
Conclusions:
- Non-propagated, prolonged contractions on small bowel manometry are a significant indicator of mechanical obstruction.
- These manometric findings should prompt further investigation for obstruction, even with equivocal imaging results.
- Manometry offers valuable insights into diagnosing intestinal mechanical obstruction.